Rectal Use of Nonoxynol-9 Among Men Who Have Sex With Men

From CDC National Prevention Information Network

April 10, 2003

Nonoxynol-9 (N-9), a detergent ingredient previously thought
to have microbicidal properties, is found in sexual lubricants,
condoms, gels and other spermicidal products. Scientists have
recently stated safety and efficacy concerns about N-9 for human
sexual use, supported by studies that found N-9 was not
protective against urogenital gonorrhea or chlamydia infection
and causes rectal mucosa disruption in humans, which may increase
risk for HIV infection during anal intercourse.

CDC, WHO and other agencies have issued several public
health statements since 2000 indicating that N-9 is not
protective against HIV and STD infection and may enhance
transmission when used under certain conditions. The authors of
the current study assessed recent rectal use of N-9 by men who
have sex with men, awareness that N-9 may not be protective
against HIV, intent to use N-9 in the future, and factors
associated with intentions to use N-9.

Participants were recruited during Fall 2001 at multiple
street locations and through community-based agencies in various
sections of San Francisco and Oakland, Calif. Recruited men
(n=1,528) were 18 years or older, lived or worked in the San
Francisco Bay Area, and reported having sex with a man in the
previous 12 months or self-identified as gay or bisexual. Men who
were eligible and willing to participate (n=1,037) were scheduled
for an interview at the Health Department or various community
locations. Fifty-five percent (n=573) of eligible and initially
willing participants completed the survey.

Participants were asked if they had heard of N-9. Men who
responded affirmatively were asked questions about their
perceptions and recent rectal use of N-9, motivations to use N-9
rectally because they thought it might be protective against HIV,
intent to use N-9 rectally in the future, and having heard
recently that N-9 may not be protective against HIV infection.
Demographic and sexual behavior variables were also measured.

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Sixty-one percent (n=349) of participants had heard of N-9.
Latinos and men of unknown HIV serostatus were less likely to
have heard of N-9; men who were HIV-positive or had higher
educational attainment were more likely to have heard of N-9.
Fifty-five percent of the 349 men aware of N-9 had heard in the
previous year that it may not be protective against HIV.

The most commonly reported sources of information that N-9
may not be protective were newspapers (54 percent) and health
agencies (50 percent), followed by magazines (37 percent) and
friends (35 percent). Relatively few men reported that they
received warnings about N-9 from the Internet (19 percent),
product labels (17 percent), sexual partners (16 percent) or TV
(15 percent).

Of men aware of N-9, 83 percent used it at some point, of
which 67 percent knowingly used N-9 during anal intercourse in
the previous year. Among men who knowingly used N-9 during anal
intercourse in the past year, 41 percent did so without a condom
because they believed or hoped it was protective.

"All MSM need to know about the dangers of using N-9
rectally," the authors wrote. "HIV care providers and prevention
specialists should actively support public health warnings and
disseminate information to reduce rectal use of N-9. Health
officials should develop targeted educational campaigns to reduce
consumer demand for N-9 products and increase demand for N-9-free
lubricants and condoms among MSM. Culturally-sensitive campaigns
in Spanish and English are needed. Agencies and communities
should work together to remove N-9 from products, venues and
websites that predominately serve MSM." In addition, the authors
recommended, "Manufacturers should consider providing warning
labels specific to rectal use on N-9 products as some have
already done. Research is needed to better understand and
intervene on unknowing use of N-9. Lastly, enhanced research is
needed of other candidate HIV and STD mircobicides, including
studies to ensure the safety and efficacy of products used for
rectal application."

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